Specialized Cognitive-Behavioral Therapy for Anxiety and OCD

You Are Not Having Intrusive Thoughts All Day; You Are Ruminating

Most people with intrusive thoughts, and most people who treat intrusive thoughts, think that these thoughts are involuntary and uncontrollable.

The truth is that the vast majority of what people call intrusive thoughts — almost all of them — are actually being thought or imagined on purpose, though the person thinking them typically doesn’t realize that.

In order to fully understand this, it’s essential to understand that according to Dr. Daniel Kahneman (Nobel-winning psychologist and economist and author of the book Thinking Fast and Slow) humans do two different types of thinking: fast, automatic thinking, and slow, directed, effortful thinking (for more information, see Wikipedia). For our purposes, I’m going to refer to these two systems as automatic thinking and analytical thinking.

Let’s use violent thoughts, also known as Harm OCD, to illustrate how these two types of thinking work in someone with OCD:

A person sees a knife near someone they love and feels afraid of stabbing that person.

What happens next? They’re afraid that that thought means they might stab the person, and they’re afraid that if they ignore it, they might end up stabbing them.

So what do they do? They try to figure out if they would actually do it. They therefore purposely imagine stabbing their loved one in order to gauge their response to that idea. And when they aren’t 100% sure what their response was, they do it again. Then they might imagine doing it another way, or start thinking about other violent ideas to gauge their response to those.

At this point they are repeatedly imagining stabbing someone, not even realizing that they’re doing it on purpose. This person will say that they are experiencing ‘intrusive thoughts’ all day. They don’t realize that the majority of these ‘intrusive thoughts’ are actually experiments that they are constantly running in their mind. In other words, this isn’t automatic thinking that they can’t control; it’s analytical thinking that they are directing towards solving a problem — specifically, figuring out if they might actually stab someone.

The initial moment when the person feels afraid of stabbings someone is the ‘intrusive thought,’ or ‘obsession.’ How long does it last? A millisecond. It’s instantaneous. Everything that follows that flash of fear is compulsive mental checking, also known as compulsive rumination.

The point of the above isn’t to blame the victim but to provide hope: Understanding that these thoughts and images are actually being invited in means that a whole lot can change when the person stops inviting them in. It also means that the advice to ‘let thoughts be there’ and not to resist them is often extremely harmful and misleading.

Even the term ‘intrusive thoughts’ is more confusing that helpful, because it fails to distinguish between an initial flash of fear that lasts less than a second and the cycle of mental checking that follows.

We need to teach people with OCD, and other people who ruminate, that they actually do have control over this thought process, and that even though it’s scary to stop, doing so is an essential step toward getting better.

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